A day care procedure requires less than 24-hour hospitalisation that involves medical operations, treatments and surgeries and are done under the influence of local anaesthesia in a hospital or in a daycare centre. Some examples include chemotherapy, dialysis, cataract, colonoscopy, and others. Not every short-term procedure or treatment qualifies as a day care procedure hence OPD consultations and hospitalisation that covers treatments and require more than 24 hours are suggested depending upon your health insurance policy.
Below are some day care procedures that you can look for.
List of Day Care Procedures Covered Under Health Insurance Policies
The Insurance Regulatory and Development Authority (IRDAI) has listed several daycare procedures that are covered under most health insurance plans.
- Dialysis
- Prostate
- Cataract
- Sinusitis
- Angiography
- Chemotherapy
- Radiotherapy
- Appendectomy
- Colonoscopy
- Septoplasty
- Sclerotherapy
- Liver aspiration
- Hydrocele
- Lithotripsy
- Piles/Fistula
Below-mentioned list includes the operations and what is included in it
Eyes
Cataract operation, removal of foreign body, corneal incision, duct operations, eyelid incision, corrective surgery for entropion, ectropion.
Ear
Stapedotomy, stapedectomy, operations on the auditory ossicles, tympanoplasty, operations on the middle ear, reconstruction of the middle ear, incision of the inner ear, other operations on the inner ear.
Nose
Nasal sinus aspiration, operation on nasal concha, foreign body removal, other operations on the nose.
Tongue
Reconstruction of the tongue, glossectomy, other operations on the tongue.
Face
Plastic surgery to the mouth, Incisions to the mouth, jaw and face, Other operations to the mouth and face.
Skin and Subcutaneous Tissue
Skin transplantation and restoration, chemosurgery to skin, incisions to skin and subcutaneous tissue, excision of diseased skin and subcutaneous tissues.
Bones
Ligament tear and meniscus tear surgery, orthopaedics and trauma surgery, fractures and sutures on tendons, dislocation surgery, other joint and bone surgery.
Other Operations
Lithotripsy, coronary angiography, haemodialysis, radiotherapy (for cancer), chemotherapy
Further, if any surgery is performed on the digestive tract, male and female reproductive organs that are also covered.
Benefits of Daycare Procedures Covered under Health Insurance Plans
You can enjoy some of these benefits when you buy health insurance plans with daycare procedures cover:
Peace of Mind
When you know that your health insurance policy covers your treatment costs and expenses incurred for the day care treatment, it's quite a relief and you don't have to worry about your finances.
Hassle Free Claim Process
You can opt for reimbursement or cashless claim method depending on the hospital selected and terms of the policy.
Save Tax
On purchasing health insurance plans which offer cover for daycare procedures, you can save tax under section 80D of the Income Tax Act, 1961 for the premium paid.
Wide Hospital Network
You can get access to a vast network of healthcare providers as these network hospitals provide you with the best medical care for you and your family even if the hospitalisation is for a brief period of time.
What is Excluded Under Day Care Treatment?
Health insurance day care does not cover all short-term medical interventions. Treatments performed by OPD are not considered day care treatments.
For example, consultations for minor injuries, seasonal diseases, and regular consultations fall under outpatient care. These procedures do not require major surgical intervention and are therefore not eligible for day care treatment.
Eligibility Criteria
The eligibility comes down to three factors to be treated under day care procedure.
- It is necessary to undergo the procedure medically.
- It requires the patient to be admitted to a hospital.
- The procedure should require less than 24 hours because of advanced medical technology.
Procedure to File a Claim Under Day Care Procedure
You can select a cashless or reimbursement claim settlement method based on the type of hospital selected for a day care treatment.
Cashless Billing via Network Hospitals
Step 1 - Select a network hospital for day care and notify your insurance company prior to admission.
Step 2 – The insurance company receives the same information from the hospital confirming that the treatment is covered under the terms of the day care treatment.
Step 3 - The hospital receives all medical expenses from the insurance company according to the terms of the day care protocol.
Claiming Reimbursement for off-grid hospitalisation:
Step 1 – Select an out-of-network hospital and notify your insurance company prior to admission.
Step 2 - Pay all costs associated with treatment out of your own pocket.
Step 3 - Submit a copy of all relevant documents to request a refund.
As you look for the right health insurance plan for you and your family, be aware of what's included and what's excluded so you can tailor your insurance to your specific needs. When looking for policies that cover day care procedures, it is wise to look for policies that cover broad categories rather than those that list specific procedures. Broader categories generally cover more surgeries and procedures and if need be you can consult an insurance advisor.
